Addendum to the Individual

Life Insurance Application

(in compliance with Insurance Commission
The Manufacturers Life Insurance Co. (Phils.), Inc. Circular Letter No. 2019-65)
Head Office: 10th Floor NEX Tower, 6786 Ayala Avenue, Makati City, 1229
Customer Care: +632 8884 7000
Domestic Toll-Free: 1 800 888 6268
Website: www.manulife.com.ph
Email:phcustomercare@manulife.com Policy No. ____________________

Declaration and Agreement

1. I agree to receive or access my policy contract, billing notice/s or any other corporate correspondence, documents or
information pertaining to such policy electronically/digitally by making use of a computer, mobile or any digital device. I
agree that the cost and expense to obtain and maintain or configure suitable software, device and/or equipment to receive
or access such documents shall be borne by me. I agree and understand that transmission of information or
communication over the Internet may be subject to interruption, transmission blackout and delayed transmission due to
the Internet traffic, or incorrect data may be transmitted due to the public and open nature of the Internet or otherwise.
The Company shall not be responsible or liable for any loss of accuracy or timeliness of any information or communication
arising from the said reasons or in relation to any malfunctions in communication facilities that are out of control of the
Company. I understand that within Manulife office hours and subject to Manulife’s standard verification procedures, I can
request for a printed copy of my policy contract for a fee while I can request for a copy of my billing notice/s or any other
corporate correspondence at no charge through the Customer Care Hotline, or at any Manulife office.
2. Pursuant to Insurance Commission’s Circular Letter No. 2019-65, as may be amended from time to time, I agree to (a) be
bound by obligations set out in relevant United Nations Security Council resolutions, relating to the prevention and
suppression of proliferation financing of weapons of mass destruction, including the freezing and unfreezing actions and
prohibitions from conducting transactions with designated persons and entities; and (b) the termination of my policy
contract / business relationship with the Company for failure to comply with the Customer Due Diligence requirements of
the Company and the relevant Anti-Money Laundering and Counter-Terrorist Financing laws and regulations.

Primary Beneficiary Information Address: Contact No.: (Area Code) Email Address
Name (Last Name, First Name, Middle Name): (please provide one (1): (if any):
Mobile: ( ) _______________

Residence: ( )____________
Mobile: ( ) _______________

Residence: ( )____________
Mobile: ( ) _______________

Residence: ( )____________
Mobile: ( ) _______________

Residence: ( )____________
Mobile: ( ) _______________

Residence: ( )____________
Contingent Beneficiary (if any) Address: Contact No.: (Area Code) Email Address
Name (Last Name, First Name, Middle Name): (please provide one (1): (if any):

Mobile: ( ) _______________

Residence: ( )____________
Mobile: ( ) _______________

Residence: ( )____________
Question: Do you own any existing The Manufacturers Life Insurance Co. (Phils.), Inc. or Manulife China Bank Life Assurance Corporation life insurance
policy or Manulife Financial Plans, Inc. pre-need plan? □ Yes □ No

Signed at _________________________ this ____________ day of _____________________, 20__________.

InsuredSignature
_____________________________________________________________ OwnerSignature
_____________________________________________________________

Proposed Insured signature over printed name Owner/Payor signature over printed name
(Signature is required if the Proposed Insured is 18 years old and above) (If other than the Proposed Insured)
ParentGuardianSignature ParentGuardianSignature
_____________________________________________________________ _____________________________________________________________

Parent/Guardian signature over printed name Parent/Guardian signature over printed name
(Signature is required if the Proposed Insured is below 18 years old) (Signature is required if the Proposed Insured is below 18 years old)

_____________________________________________________________ _____________________________________________________________

Signature of Authorized Signatory #1 (for Institutions) over Signature of Authorized Signatory #2 (for Institutions) over
printed name printed name

AgentSignature
_____________________________________________________________ _____________________________________________________________

Financial Advisor (as witness) signature over printed name Financial Advisor Code